nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2008-12-2-56-60nefr-1061Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSКОНЦЕНТРАЦИЯ АЛЬДОСТЕРОНА, СОСТОЯНИЕ ГЕМОСТАЗА И ЭНДОТЕЛИАЛЬНОЙ ФУНКЦИИ У БОЛЬНЫХ НА ПРОГРАММНОМ ГЕМОДИАЛИЗЕ И ВЛИЯНИЕ НА НИХ ТЕРАПИИ СПИРОНОЛАКТОНОМCONCENTRATION OF ALDOSTERONE, STATE OF HEMOSTASIS ANВ ENDOTHELIAL FUNCTION IN PATIENTS ON PROGRAMMED HEMODIALYSIS AND EFFECTS OF EXPOSURE TO THERAPY WITH SPIRONOLACTONEКарабаеваА. Ж.KarabaevaA. Zh.

кафедра нефрологии и диализа факультета последипломного обучения 

ЕсаянА. М.EssaianA. M.

кафедра нефрологии и диализа факультета последипломного обучения 

КаюковИ. Г.KayukovI. G.

кафедра нефрологии и диализа факультета последипломного обучения 

197022, Санкт-Петербург, тел.: (812)- 346-39-26, факс: (812)-234-91-91

kaukov@nephrolog.ruСанкт-Петербургский государственный медицинский уни­верситет им. акад. И.П. Павлова, Санкт-ПетербургRussian Federation2008100220081225660Copyright © Карабаева А.Ж., Есаян А.М., Каюков И.Г., 20082008Карабаева А.Ж., Есаян А.М., Каюков И.Г.Karabaeva A.Z., Essaian A.M., Kayukov I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1061

ЦЕЛЬ ИССЛЕДОВАНИЯ. Изучить уровень концентрации альдостерона плазмы,состояние системы гемостаза и функции эндотелия у больных с хронической болезнью почек (ХБП) V стадии на программном гемодиализе и оценить влияние на них терапии спиронолактоном. ПАЦИЕНТЫ И МЕТОДЫ. 83 пациента с ХБП V стадии на программном гемодиализе. У обследованных определяли концентрацию альдостерона плазмы (КАП), оценивали функциональное состояние эндотелия с помощью биохимических маркеров – ингибитора активатора плазминогена 1 типа (PAI-1), тканевого активатора плазминогена (t-PA), эндотелина-1, состояние тромбоцитарного и коагуляционного звеньев гемостаза оценивали по морфофункциональной активации и агрегации тромбоцитов, концентрации фибриногена по Клауcсу, активности антитромбина-III (АТ-III), уровня D-димера методом латексной агглютинации до и после 6-месячного курса терапии спиронолактоном. РЕЗУЛЬТАТЫ. У всех больных исходно имелось значительное повышение уровня альдостерона крови – 478±99,96 пг/мл (норма - до 160,0±29,23 пг/ мл). На фоне терапии спиронолактоном отмечено достоверное снижение уровня альдостерона до 346,45±58,1 пг/мл (р=0,009), достоверное снижение активности маркеров эндотелиальной дисфункции: эндотелина-1 с 0,63±0,09 fmol/ml до 0,23±0,03 (р=0,002), PAI-1 с 5,69±0,24 до 3,06±0,25 U/ml (р<0,001); повышение уровня t-PA с 5,03±0,3 до 5,64±0,3. Исследование системы гемостаза выявило активацию тромбоцитарного звена: повышение суммы активных форм тромбоцитов и увеличение числа тромбоцитов, вовлеченных в агрегаты, за счет образования внутрисосудистых агрегатов малого размера (р<0,05), повышение концентрации фибриногена (р<0,05) по сравнению с группой здоровых лиц, значения АТ-III находились на нижней границе референтных величин, 30% больных имели повышенный уровень D-димера. Достоверных изменений в показателях гемостаза после лечения спиронолактоном не выявлено. ЗАКЛЮЧЕНИЕ. Терапия спиронолактоном у больных на программном гемодиализе приводит к улучшению состояния эндотелиальной функции. При этом сохраняется дисбаланс в системе гемостаза, характеризующийся активацией тромбоцитов, напряжением в системе АТ-III, повышением уровня D-димера, что может повышать риск развития сосудистых катастроф у больных с хронической болезнью почек.

THE AIM of the investigation was to study the level of the concentration of plasma aldosterone, the state of the hemostasis system and function of endothelium in patients with the V stage chronic kidney disease (CKD) on programmed hemodialysis and to estimate the effects of spironolactone therapy on them. PATIENTS AND METHODS. In the investigated 83 patients with V stage CKD on programmed hemodialysis the following indicators were studied: determination of the concentration of plasma aldosterone (CPA), assessment of the functional state of the endothelium using biochemical markers – plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA), endothelin-1, state of thrombocytic and coagulation link of hemostasis were estimated by morphofunctional activation and aggregation of thrombocytes, concentration of fibrinogen after Clauss, activity of antithrombin-III (AT-III), D-dimer level by the method of latex agglutinationb before and after 6-month course of therapy with spironolactone. RESULTS. All the patients initially had considerably elevated level of blood aldosterone -478±99.96 pg/ml (normal – up to 160.0±29.23 PG/MK0 pg/ml). Against the backgroung of spironolactone therapy there was a reliably decreased level of aldosterone up to 346.45±58.1 pg/ml (p=0.009), reliably decreased activity of the endothelial dysfunction markers: endothelin-1 from 0.63±0.09 fmol/ml to 0.23±0.03 (p=0.002), PAI-1 from 5.69± 0.24 up to 3.06± 0.25 U/ml (p<0.001); elevation of the level of t-PA from 5.03±0.3 up to 5.64± 0.3. The investigation of the hemostasis system revealed activation of the thrombocytic link: increased sum of active forms of thrombocytes and greater number of thrombocytes involved in aggregates at the expense of the formation of intravascular aggregates of small size (p<0.05), increased concentration of fibrinogen (p<0.05) as compared with the group of healthy subjects, the value of AT-III was at the low border of the reference values, 30% of patients had higher level of D-dimer. No reliable changes in the indices of hemostasis after treatment with spironolactone were found. CONCLUSION. Spironolactone therapy in patients on programmed hemodialysis results in the better state of the endothelium function. The disbalance in the system of hemostasis remains the same, and is characterized by activation of thrombocytes, tension in the system AT-III, elevation of the D-dimer level, that might increase risk of the development of vascular catastrophies in patients with chronic kidney disease.

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The authors declare that there are no conflicts of interest present.